组织多普勒成像评价永久起搏患者心室收缩同步性及心功能

Evaluation of left ventricular synchronicity and cardiac function by tissue Doppler imaging in patients with permanent cardiac pacing

目的探讨组织多普勒超声心动图评估不同起搏模式对左心室收缩同步性及心功能的价值。方法 15例植入双腔起搏器的患者,分别以AAI、DDD和VVI模式起搏5min和3个月后行彩色和组织多普勒检查,测量左心室射血分数(LVEF)、每搏输出量(SV)、12节段收缩速度达峰时间标准差(TS-SD)、收缩峰速度平均值(Vs-m)、舒张早期速度达峰时间标准差(TD-SD)、舒张早期峰值速度(E)、舒张晚期峰值速度(A)、舒张早期峰值速度(Em)、舒张晚期峰值速度(Am),并计算E/A、Em/Am和E/Em。结果在5min和3个月时AAI的TS-SD与TD-SD明显小于DDD和VVI(P<0.05)。三种起搏模式TS-m和E/A在5min和3个月均无明显差异(P>0.05)。DDD和VVI起搏5min后LVEF、Em/Am、E/Em与AAI相比无明显差异(P>0.05),但VVI模式SV明显低于AAI及DDD(P<0.05)。随访3个月LVEF在AAI、DDD和VVI分别为(70.90±12.99)%、(65.75±6.49)%和(60.25±7.13)%(P<0.05);舒张功能随访3个月时有差异,AAI优于DDD及VVI(P<0.05)。结论组织多普勒成像可以客观准确地评估永久起搏患者心室收缩同步性及心功能。

Objective To investigate the value of tissue Doppler imaging（TDI）in evaluating left ventricular synchronicity and cardiac function in patients with permanent cardiac pacing.MethodsFifteen patients with implanted bipolar DDD pacemakers for treating sick sinus syndrome were enrolled in this study.The left ventricular systolic and diastolic synchrony and functionwere assessed by TDI and colour Doppler echocardiography in the AAI,DDD and VVI modes at 5min and 3 months.Results Compared with DDD and VVI modes,TS-SD and TD-SD in AAI modewere lower（P0.05）.No significant differences were found in VS-m and E/A at 5min and 3months.There were no significant differences in the parameters of left ventricular ejection fraction（LVEF）,Em/Am and E/Em among AAI,DDD and VVI modes after 5min（P0.05）,however,the stroke volume（SV）was decreased in VVI mode（P0.05）.The values of LVEF in AAI,DDD and VVI modes were（70.90±12.99）%,（65.75±6.49）% and（60.25±7.13）% at 3 months,respectively（P0.05）.DDD mode and VVI mode decreased diastolic function compared with AAI mode after pacing for 3 months（P0.05）.Conclusion The TDI as a technique for the evaluation of ventricular synchronicity and cardiac function is objective and precise.